Application of PERT/CPM to the Care of Pulmonary Lobectomy Patients

應用PERT/CPM於肺葉切除患者的照顧

李麗傳(Li-Chuan Lee) ； 李世俊(Shih-Chun Lee) ； 王桂芸(Kwua-Yun Wang) ； 許正義(Jane-Yi Hsu)

《Journal of Medical Sciences》 19卷5期 (1999/04) Pp. 273-283

摘要

由於醫療經費的裁減，造成了臨床醫療的許多改變。應用要徑法（Critical Path Method, CPM）與計畫評核術（Program Evaluation Review Technique, PERT）為心臟手術患者設計的照顧之臨床路徑，證明可以縮短患者的住院天數、減少醫療用以及提昇照顧的品質。本研究的目地是將PERT/CPM應用於臨床肺葉切除患者的照顧，求證是否能獲得相同的結果。自西元1997年9月起我們成立了臨床路徑醫療小組，成員每月開會一次，設計肺葉切除患者照顧的臨床路徑。自收集的24位肺葉切除出院患者的病歷中取得基本資料，再做PERT/CPM之方法將基本資料分析整理後，制定照顧的流程圖與步驟的時刻表。於西元1997年12月起，採用這已完成的肺葉切除患者照顧的臨床路徑，共有6位肺葉切除患者參與了前驅研究。結果顯示，將PERT/CPM應用於臨床肺葉切除患者照顧的臨床路徑，因其主張患者早期出院，故自實施後迫使醫生改善了其醫療行為，導致減少了患者的住院天數與再住院率。

關鍵字

肺葉切除患者 ； PERT/CPM ； 住院天數 ； 再住院率

並列摘要

Critical paths have been established primarily as a result of imposed economic constraints. The Critical Path Method (CPM) and Program Evaluation Review Technique (PERT) have been used as a framework to establish an effective clinical pathway for open-heart surgery patients and have been shown to improve patient's length of stay, cost, and quality of care. This study investigated whether PERT/CPM can be used to realize similar outcomes with pulmonary lobectomy patients. A multidisciplinary team met on a monthly basis starting in September 1997 to develop a lobectomy clinical path. Twenty-four charts of discharged patients were reviewed retrospectively for basic data collection. The PERT/CPM was used to analyze variances from the clinical pathway. A network flow diagram was used to determine whether sequential relationships existed between activities and clinical outcomes in the care process. Based on these findings, a critical pathway was developed detailing daily goals for the patients and care teams. The pathway was initiated on December 1, 1997. A post PERT/CPM study of 6 cases was performed. The results showed that the pulmonary lobectomy pathway resulted in earlier discharge and a reduction in readmission rates. Important reasons for the success of this method appear to be a multidisciplinary approach, identification and control of high cost areas throughout the hospitalization period, specific care within a standardized frame, and identification of reasons for prolonged stay.

並列關鍵字

pulmonary lobectomy patient ； PERT/CPM ； length of stay ； early readmission